Franklin asks for face time with Mission

It’s been more than two weeks since Mission Health announced Angel Medical Center would stop delivering babies as of July 14, but the Franklin community still has many unanswered questions and concerns.

Mission made the announcement April 25 by sending out a press release and held a press conference in Asheville April 28 to discuss the decision, but Mission representatives have yet to address the backlash coming out of Macon County.

Residents have made it clear they want the labor and delivery unit at AMC to stay —they’ve rallied at the gazebo in downtown, protested outside the hospital while the AMC board held a meeting inside and formed Operation Heartbeat Two — a community action group tasked with reversing Mission’s decision.

The first Operation Heartbeat group formed in Franklin in the early ‘70s to raise money to buy the hospital and turn it into a community hospital. The group was successful at raising $300,000 during that campaign and now they hope they can change Mission’s mind.

Mission’s CEO Ron Paulus and AMC President Karen Gorby have said the decision to close the labor and delivery unit was for financial reasons. With the unit losing more than $1 million a year, Gorby said the cost was putting the rest of the hospital’s services at risk. Part of the problem, according to Paulus, is that 75 percent of AMC’s patients are on Medicaid or Medicare and reimbursements from the federal and state governments are not keeping up with the cost of services.

Unanswered questions

But to residents, a $1 million annual loss to ensure expecting mothers have a close by option for deliveries seems like a drop in the bucket in the grand scheme of things, especially for a large health care system like Mission.

Without the service at AMC, women will have to make the 25-minute drive over Cowee Mountain to deliver at Harris Regional Hospital — a Duke LifePoint affiliated hospital — a 45-minute drive to Haywood Regional Medical Center — also a Duke LifePoint hospital — or travel an hour and a half to get to Mission Hospital in Asheville.

With the unpredictable nature of childbirth and a high poverty level in Macon County, residents say that is just unacceptable.

“You took an important part away from our community forcing moms to go to Asheville to have a baby! Did you even bother thinking about those who have no car?” Kiomarie Wilson commented on AMC’s Facebook page.

In response to Wilson’s concern, AMC responded by saying people without a car could be transported to the hospital via ambulance.

“You forgot to mention how much that ambulance ride costs,” replied Jensine Crossman.

When asked about the impact on women in Franklin, Paulus pointed to the fact that a quarter of pregnant patients from Macon County already travel to Mission in Asheville to deliver their babies. He also said the number of babies being born in the western counties hasn’t increased and census data doesn’t show any signs of an increase. That may be true, but the number of births happening at AMC in recent years has increased steadily — 161 babies in 2012 compared to 374 babies in 2016.

Mission sees Franklin as an aging community, which is why Mission is looking to focus more on providing services for the elderly population.

The problem is Franklin doesn’t want to be just a retirement community and is actually trying to attract more young families to the area for the sake of economic development. Many young entrepreneurs have already settled in Franklin for the quality of life and to start a family, but how can the county attract young families without necessary health services those families expect from a local hospital?

There’s another part of this debate that many say that doesn’t add up — this time last year Mission Health announced it would be spending $4 million at AMC to expand the women’s unit to accommodate the growing number of births at the hospital. So what changed?

During the Asheville press conference, Paulus said a closer examination of the AMC facility by architects revealed more structural problems than originally anticipated, making renovations unfeasible.

Mission is also promising build a new $45 million hospital in Franklin in the next few years, but residents still think deliveries are more important than a new hospital. Plans for a new hospital will not include a labor and delivery unit because it would cost another $5 million, but Gorby said the new hospital will have room for growth if finances improve and AMC wants to bring back labor and delivery.

What they want

Members of Operation Heartbeat Two have written a letter to Paulus asking that Mission representatives come to Franklin to hold a community meeting and address some of these unanswered questions.

“The original 1971 Operation Heartbeat raised $300,000 for Angel Community Hospital. That would be $2 million in today’s economy,” the letter reads. “Operation Heartbeat Two is requesting that you speak to the community at a date convenient to you. Our group feels that Mission has not adequately spoken to the community about the decision to close L&D at Angel Medical Center.”

The group promises no protests, signs or disrespect — they just want help understanding and they want to know what they can do to change it. They want to know if there are any alternatives before this decision is implemented.

Macon County commissioners were scheduled to meet Tuesday night after press time and the AMC labor and delivery unit was on the agenda. Members of Operation Heartbeat planned to be at the meeting to present their views on the issue and encourage the county to take some kind of action.

History

Some people in Franklin have been asking whether Mission had considered cutting its ties with AMC if it meant the local hospital would have more control over keeping labor and delivery services. However, that may be easier said than done since Mission stepped in to save AMC from going belly up and has made major investments in the community since then.

AMC officially came under the Mission umbrella in 2013 when a management agreement was signed, though Mission never purchased the hospital. The deal was AMC would need to be self-sustaining — meaning Mission Health wouldn’t pull from its own coffers to balance AMC’s budget.

“The hospital had lost approximately $7 million in the three preceding years, was in default of its debt obligations and was out of cash,” Gorby said. “After the affiliation with Mission, Angel’s debt obligations (about $16 million) were transferred to Mission and operating performance, quality and safety performance and other factors dramatically improved.”

Being an affiliate with a larger system like Mission Health also meant access to better deals for medical supplies and equipment, more training opportunities and a better benefits packages for employees (a key for recruitment and retention) and other consultant services AMC couldn’t afford on its own.

The goal was not to make AMC profitable — the goal was always to have the small not-for-profit hospital break even. Paulus and Gorby said that is still the only goal for AMC.

The new Mission affiliation also meant changing how the AMC Board of Trustees operated. Prior to the affiliation, the AMC board had full accountability for all aspects of the hospital. As part of the shift of responsibility to Mission, certain powers were transferred from Angel to Mission, including: co-selection of the hospital president, final approval of the operating and capital budgets and the right to appoint up to five directors to the AMC board, at least one of whom must be present to constitute a quorum to transact business.

The Angel board did retain the ability to approve any material change in a service —such as the modification of the women’s service line to eliminate labor and delivery — as well as changes in physician groups providing hospital-based services, the name of Angel Medical Center, the bylaws and the mission, vision or values of the organization.

However, there was some confusion over when the AMC board had approved the labor and delivery closure. Paulus had stated during the press conference that the decision was made following a recommendation from Gorby, approval from the AMC board and a blessing from the Mission board, but that’s not the way things went down.

Gorby said the AMC board was set to vote on the closure prior to the announcement being made on April 25, but unforeseen circumstances stalled the meeting.

“Numerous contingencies interfered with the original Angel Medical Center Board meeting, including the interruption of the meeting because of a threat of violence that required an evacuation and lockdown of the facility,” Gorby said. “Therefore, at the time of the original announcement, while there had been significant discussion, the Angel Medical Center Board had not voted on the change of service.”

The AMC board did vote on the issue on Monday, May 8, and unanimously approved the closure, according to Gorby.